1. American College of Physicians recommends against routine pelvic exam, finds harms outweigh any demonstrated benefit
ACP's new guideline suggests a major change in clinical practice
In a new evidence-based clinical practice guideline being published in Annals of Internal Medicine (http://www.
ACP's guideline does not apply to Pap smear screening, only the pelvic examination. ACP states that when screening for cervical cancer, the recommended examination should be limited to visual inspection of the cervix and cervical swabs for cancer and for some women human papillomavirus (HPV), and does not need to include the bimanual examination. ACP found that the diagnostic accuracy of the pelvic examination for detecting gynecologic cancer or infections is low. ACP advises that the pelvic examination is appropriate for women with symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems, or sexual dysfunction.
ACP's guideline includes High Value Care advice to help doctors and patients understand the benefits, harms, and costs of the pelvic examination so they can pursue care together that improves health, avoids harms, and eliminates wasteful practices.
The guideline is based on a systematic review of 52 published studies that found little evidence to support routine pelvic exams for average-risk women with no gynecological symptoms. Among the findings, research showed that pelvic exams cause pain, discomfort, fear, anxiety, or embarrassment for about a third of women and some studies suggest that up to eight in 10 women experience emotional distress because of the test. In addition, false-positive results may lead to unnecessary, invasive, and potentially harmful diagnostic procedures.
The authors of an accompanying editorial predict that ACP's guideline will be controversial because it recommends against an exam that has long been considered a fundamental component of the well-woman visit. They write, "Regardless of whether the ACP statement changes practice among obstetrician-gynecologists, it should provide a needed prompt for champions of this examination to clarify its goals and quantify its benefits and harms. Even if net benefit is ultimately demonstrated, the question of value will need to be addressed to understand the resources required to achieve that benefit."
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2. Initial treatment with efavirenz-containing antiretroviral regimen doubles risk for suicidal behaviors
Initial treatment for HIV infection with an efavirenz-containing antiretroviral regimen doubles a patient's risk for suicidal thoughts, attempts, or completion, according to an article being published in Annals of Internal Medicine (http://www.
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Daily oral preexposure prophylaxis (PrEP) with a tenofovir-based regimen protects against herpes simplex virus 2 (HSV-2) acquisition, according to an article being published in Annals of Internal Medicine (http://www.
Note: The URL will go live at 5:00 p.m. on Monday, June 30 and can be included in news stories. For an embargoed PDF, please contact Megan Hanks or Angela Collom. To speak with an author, please contact Toni Maddox at 206-520-3825 or firstname.lastname@example.org.